The aim of this thesis was to develop and make a quality assessment of a tool, which includes a questionnaire and a dialogue process that could be useful for workplace health promotion from a salutogenic point of view. The studies have been performed within two health care organizations between 2005 and 2009, together with hospital staff. Two questionnaire studies were conducted (n=446 n=505, respectively). A focus group interview study was performed (n=78), and meetings were held in an action research process for applying a questionnaire process at two wards (n=69). The result shows a development process for a multi-dimensional questionnaire, the Work Experience Measurement Scale (WEMS), which can be used to measure work experiences from a salutogenic perspective. WEMS was shown to be a functional workplace health promotion questionnaire with the ability to discriminate between groups. Its psychometric properties support its applicability in health care settings and offer a possibility to measure trends over time regarding employees´ work experiences. A dialogue structure for progress in the questionnaire process is presented. It describes what to precede and how to proceed through a workplace questionnaire process to foster applicability, meaningfulness, and sustainability. Through WEMS, the outcome of work-related Specific Enhancing Resources (SER) may be highlighted and strengthened in workplace activities. When used as a dialogue tool in a continuous questionnaire process, WEMS has the potential of being a useful assessment tool in workplace health promotion. Such a dialogue tool is useful in discussions and tangible for the work of enhancing positive human capabilities and resources (SER) that improve work performance.

People spend much of their timeat work and health is affected by how we experience our everyday work situation. Health in the workplace is important for public health and seems to improve the occupational health of theemployees. The pace of work and requirements have hasincreased at work and it's not equal accepted to have an obstacle that makesyour work capacity decreases. Despite this, there are health factors that enable us meet therequirements and can maintaingood health in the workplace. Theaim of the studywas to see if there has beena change in healthcare workers work-related health over time. The Method entailed analysis of the existing data materials researchersfrom Kristianstad University have developed through cross-sectional studies in hospitals insouthern Sweden during the fouroccasions between 2005-2009. The result shows thatthe reported work-related health has improved markedly over the years within the professional categories. By looking at thevarious health factors, there wasa opportunity to see if the factors affect the occupational groupsdifferent. Conclusion, based on the results, it can be shown thathealthcare workers work-related health has been positively affected by various health factorswhich have enhanced in the workplace. Health promotionis therefore important for thepositive development of the work-relatedhealth. / Människan tillbringar en stor del av livet på arbetet och hälsan påverkas av hur vi upplever vår vardagliga arbetssituation. Hälsa i arbetslivet är därför ett viktigt folkhälsomål som verkar för att förbättra den arbetsrelaterade hälsan hos anställda. Arbetstempot och kraven har ökat ute på arbetsplatserna och det är inte lika accepterat att ha något hinder som gör att din arbetsförmåga minskar. Det finns hälsofaktorer som gör att vi klarar av kraven och kan behålla en god hälsa i arbetslivet. Syftet med studien var att påvisa om det har skett en positiv eller negativ förändring i sjukvårdspersonalens arbetsrelaterade hälsa genom att studera vilka faktorer som har förändrats under en fyraårs period. Metoden innebar analys av befintligt datamaterial som forskare från Högskolan Kristianstad har tagit fram genom tvärsnittsstudier på två olika sjukhus i södra Sverige under fyra tillfällen mellan åren 2005-2009. Resultatet visar att den rapporterade arbetsrelaterade hälsan har förbättrats markant mellan åren inom yrkeskategorierna. Genom att titta på olika hälsofaktorer fanns det möjlighet att se om de olika faktorerna påverkar yrkesgrupperna olika. Slutsats, utifrån resultatet kan det visas att sjukvårdspersonalens arbetsrelaterade hälsa har påverkats positivt vilket relateras till olika hälsofaktorer har förbättrats på arbetsplatsen. Det hälsofrämjande arbetet är därmed viktigt för att kunna fortsätta få en positiv utveckling av den arbetsrelaterade hälsan.

Aim: This thesis aims to describe and analyse the concept of health-promoting leadership, including criticalconditions for implementation and evaluation of such leadership. Methods: Three case studies and one conceptual analysis were conducted using qualitative methods, including interviews, observations and document analysis. The qualitative data material in study III was supplementedwith quantitative material from a leadership survey. Study I was a qualitative case study of a Swedish industrial company characterized by a low sickness rate, a structure of self-managed teams and an organisational culturethat aimed to develop employee skills and influence. Study II was a phenomenograpic study of health-promoting leadership, as described by 20 individuals employed in Swedish municipalities. Study III was a case study of anintervention programme for the development of health-promoting leadership conducted in four city districts of Gothenburg, Sweden. Study IV was a case study on collaboration in workplace health promotion between municipalities in a Swedish region. Results: Study I illustrates how a company leader developed and influenced organisational culture, including the employees’ control over their work situation, participation and personal development. The results of this study emphasise the importance of considering contextual factors when evaluating the role of leadership in promotinghealth at work. Study II describes health-promoting leadership in three different ways: organising health promoting activities, supportive leadership style, and developing a health-promoting workplace. Interviewees frequently linked good leadership in general with good employee health. Study III shows the importance ofregarding the development of health-promoting leadership as a contribution to building organisational capacityfor a health-promoting workplace. The intervention programme was implemented in an existing managementgroup already producing action plans for workplace health promotion. Such integration is an important part ofbuilding organisational capacity for creating and sustaining a health-promoting workplace. Study IV shows thatcollaborative health-promoting leadership is viewed as a strategy to reduce the sickness rate amongmunicipalities in a region. The study implies that collaborative workplace health promotion should be organisedinitially on a small scale, giving participants the time and opportunities to develop mutual trust. Moreover, StudyIV demonstrates the importance of including participants with differing levels of knowledge and experienceabout workplace health promotion. Conclusions: Health-promoting leadership can be defined as leadership that works to create a culture for healthpromotingworkplaces and values, to inspire and motivate employee participation in such a development. Healthpromotingleadership can also be viewed as a critical part of organisational capacity for health promotion,including managerial knowledge and skills as well as organisational policies and structures that support a healthpromotingworkplace. Therefore, leadership involvement in the systematic development of both the physical andpsychosocial work environment is important. / Syfte: Det övergripande syftet med denna avhandling är att beskriva och analysera begreppet hälsofrämjandeledarskap, vilket även inkluderar förutsättningar för utveckling och utvärdering av ett sådant ledarskap. Metoder: Kvalitativa metoder har tillämpats i avhandlingens alla studier, inklusive intervjuer, observationer ochdokumentanalys. I studie III har det kvalitativa datamaterialet kompletterats med kvantitativa data från enledarskapsundersökning. Tre fallstudier och en konceptuell analys genomfördes. Studie I var en kvalitativfallstudie av ett svenskt industriföretag med låg sjukfrånvaro och med en arbetsorganisation som syftade till attutveckla medarbetarnas kompetens och inflytande i sitt arbete. Studie II var en fenomenografisk studie av hurhälsofrämjande ledarskap beskrevs bland 20 personer anställda i svenska kommuner. Studie III var en fallstudieav ett interventionsprogram för utveckling av hälsofrämjande ledarskap i fyra stadsdelar i Göteborg. Studie IVvar en kvalitativ fallstudie av samverkan mellan kommuner i en svensk region kring att skapa hälsofrämjandearbetsplatser. Resultat: Studie I visar hur en företagsledare har utvecklat och påverkat en företagskultur som främjar deanställdas kontroll över arbetssituationen, samt deras delaktighet och personlig utveckling. Resultaten visar påvikten av att ta hänsyn till kontextuella faktorer vid utvärdering av vilken betydelse ledarskapet har för att främjahälsa på arbetsplatsen. Hälsofrämjande ledarskap beskrivs i studie II på tre olika sätt: att organiserahälsofrämjande aktiviteter, en stödjande ledarskapsstil, samt att utveckla en hälsofrämjande arbetsplats.Konceptet användes ofta bland intervjupersonerna för att länka idéer om ett gott ledarskap i allmänhet till deanställdas hälsa. Studie III visar på vikten av att se ledarskap som ett bidrag till utvecklingen av enhälsofrämjande arbetsplats. Programmet genomfördes i befintliga ledningsgrupper som tog fram handlingsplanerför en hälsofrämjande verksamhetsutveckling. Denna typ av integration är ett viktig led i att utveckla denorganisatoriska kapaciteten för att vara en hälsofrämjande arbetsplats. I studie IV sågs samverkan kringhälsofrämjande ledarskap som en strategi för att minska sjukskrivningar bland kommunerna i regionen. Studienpekar på vikten av att till en början organisera samverkan kring utveckling av hälsofrämjande arbetsplatser imindre skala för att ge samverkansparterna tid och möjligheter att utveckla ett ömsesidigt förtroende förvarandra. Studien visar också att det är viktigt att involvera olika samverkansparter med kompletterande kunskaper och erfarenheter om arbetshälsa. Slutsatser: Hälsofrämjande ledarskap kan definieras som ett ledarskap som arbetar för att skapa enhälsofrämjande arbetsplatskultur. En sådan kultur innefattar värderingar som inspirerar och motiverar deanställda att delta i utvecklingen mot en hälsofrämjande arbetsplats. Hälsofrämjande ledarskap kan också sessom en viktig del av den organisatoriska kapaciteten för att främja hälsa, det vill säga chefers kunskaper ochfärdigheter såväl som riktlinjer och strukturer i organisationen som understödjer en hälsofrämjande arbetsplats.Det är därför viktigt med ett ledarskapsengagemang i den systematiska utvecklingen av både den fysiska ochpsykosociala arbetsmiljön.

I det komplexa och moderna arbetslivet förändras både människor och organisationer. Detta leder till att hälsofrämjande på arbetsplatser får en allt större betydelse i samband med att alla förändringar ställer nya krav på organisationer och dess anställda. Syftet med studien var att undersöka på vilka sätt chefer aktivt arbetar för att främja och bibehålla den arbetsrelaterade hälsan hos medarbetare. Det genomfördes kvalitativa telefonintervjuer med åtta första linjens chefer, vilka var aktiva inom skolverksamheten, fritidsgårdsverksamheten, rättspsykiatriska vården och kommunen. Intervjuerna bearbetades genom tematisk analys, något som visade att chefer främjar och bibehåller sina medarbetares hälsa genom att ge medarbetarna möjlighet till kontroll och delaktighet i arbetet samt genom ett närvarande och stöttande ledarskap. Studien ansågs vara praktiskt användbar av nuvarande och framtida chefer som vill arbeta hälsofrämjande samt av intresse för de undersökta arbetsplatserna där studien kan fungera som ett synliggörande underlag kring det hälsofrämjande arbetet.

Flera rapporter visar på att hälsofrämjande insatser inom organisationer kan leda till positiva resultat på hälsa, effektivitet och kvalitet. Arbetsgivare ses som centrala aktörer i att förebygga hälsa genom hälsofrämjande åtgärder. Tidigare studier har pekat på att åtgärderna bör innefatta såväl individen som organisationen samt att både medarbetare och ledare måste vara delaktiga. Därmed är det aktuellt att undersöka vilka förutsättningar som är viktiga för att uppnå en hälsofrämjande arbetsplats. Syftet med studien var att bidra med kunskap om hur den hälsofrämjande arbetsplatsen uppfattas och fungerar, både utifrån medarbetare och ledares perspektiv. På så sätt avsåg studien bidra till organisationer som vill arbeta för att skapa effektiva och hållbara arbetsplatser. En kvalitativ fallstudie har genomförts där semistrukturerade intervjuer har utförts för att samla in empirisk data om deltagarnas uppfattningar. Dessutom har viss sekundärdata samlats in i form av information om den studerade organisationen. Vidare har en litteratursökning genomförts för att undersöka tidigare forskning inom ämnesområdet. Där framkom att en investering i en hälsofrämjande arbetsplats skapar förutsättningar för ökad produktivitet och effektivitet. Tidigare forskning har även fokuserat mycket på ledarskapet då det anses vara en viktig faktor. Resultatet av denna studie visade på att den hälsofrämjande arbetsplatsen handlar om många olika delar inom både hälsa och arbetsmiljö. Både medarbetarna och ledarna menade att insatserna gynnade både individen och organisationen på flera nivåer. Att integrera det hälsofrämjande arbetet i organisationens befintliga system ansågs som en viktig faktor. Vidare poängterades att tid, resurser, positivt ledarskap samt delaktighet från hela organisationen var de viktigaste förutsättningarna för att uppnå en hälsofrämjande arbetsplats. Studiens resultat analyserades och visade på att en investering i humankapital i form av hälsofrämjande åtgärder skapar förutsättningar för en positiv resultatkedja inom organisationen, vilken slutligen bör resultera i en effektiv och hållbar arbetsplats. Vidare analyserades att ledarna har en viktig roll i att förebygga riskfaktorer och främja friskfaktorer, vilket också Arbetsmiljöverket tydliggjort i och med den nya föreskriften om organisatorisk och social arbetsmiljö. / Several reports show that health promotion efforts within organizations can lead to positive results in health, efficiency and quality. Employers are seen as key players in the prevention of health through health promotion. Previous research has indicated that the activities should include both the individuals and the organization, and both employees and managers need to be involved. This shows that it is relevant to examine which conditions that are essential to achieve a workplace health promotion. The purpose of the study was to contribute to the knowledge about how the workplace health promotion is perceived and how it works, both from employees and leaders' perspective. Thereby, the study aimed to contribute to organizations that want to create effective and sustainable workplaces. A qualitative case study was conducted and semi-structured interviews were carried out to collect empirical data on participants' perceptions. Additionally, some secondary data was collected in the form of information about the studied organization. Furthermore, a literature research was conducted to examine previous research in the field. It showed that an investment in a workplace health promotion creates conditions for increased productivity and efficiency. Previous research has also focused a lot on leadership as it is considered as an important factor. The results of this study showed that workplace health promotion involves many different elements within both health and working environment. Both the employees and the leaders argued that efforts benefited both the individual and the organization on several levels. Integrating the workplace health promotion in the organization's existing systems was considered an important factor. It was further argued that time, resources, positive leadership and involvement of the whole organization was the most important conditions for achieving a workplace health promotion. The study's results were analyzed and showed that an investment in human capital in the form of health promotion creates the conditions for a positive chain of results within the organization, which in the end finally should result in an effective and sustainable workplace. Further analysis showed that the leaders have an important role in preventing risk factors and promoting health factors, which the Swedish Work Environment Authority also made clear in the new provisions about organizational and social work environment.

<p><strong>Bakgrund: </strong>Den största delen av den vuxna befolkningen befinner sig i arbetslivet och därför är arbetsplatsen en viktig arena i arbetet med att förbättra folkets hälsa. I verksamheters systematiska arbetsmiljöarbete finns verktyget medarbetarsamtal som syftar till att öka förståelsen för organisationens uppgift samt att ge medarbetaren ett större handlingsutrymme. <strong>Syfte: </strong>Att studera chefers och medarbetares upplevelser av hur arbetsmiljö och livsstilsfrågor diskuteras och behandlas i medarbetarsamtalet. <strong>Metod: </strong>Fyra fokusgrupper genomfördes med chefer och medarbetare från proAros olika verksamheter. <strong>Resultat: </strong>Mål, strategier, utveckling samt en enad riktning av verksamheten diskuterades som viktiga delar i medarbetarsamtalet. Tydligt ledarskap, stöd och uppmuntran, delaktighet, det egna ansvaret samt hur mål och krav är anpassade för den rådande situationen var faktorer som upplevdes påverka medarbetarsamtalet. Gällande arbetsmiljö diskuterades främst hur trivseln i arbetslaget var och hur samarbetet fungerade. Gällande livsstilsfrågor diskuterades friskvård, det egna ansvaret för sin hälsa samt balansen mellan arbetsliv och privatliv. <strong>Slutsats: </strong>Den fysiska arbetsmiljön är fortfarande av betydelse för de anställdas hälsa då proAros verksamheter till större delen består av människobehandlande yrken med påfrestande arbetsbelastningar. Frågan om att hitta balans är viktig för den arbetsrelaterade hälsan och bör därför göras mer medveten. Det promotiva hälsoarbetet bör därför integreras även i medarbetarsamtal.</p> / <p><strong>Background: </strong>The majority of the adult population is present in working life and the workplace is therefore an important setting in the efforts to improve public health. In the organizations’ day-to-day work to improve the work environment it is possible to use performance appraisal that aims to increase the understanding for the organization’s commissions and to increase the employees’ participation. <strong>Aim: </strong>To study directors and coworkers experiences about how work environment and lifestyle are discussed and managed during performance appraisal. <strong>Method: </strong>Four focus groups where performed with directors and co-workers from different units at proAros. <strong>Result: </strong>Objectives, strategies, development, and a united direction in the organization were discussed as important for performance appraisals. Leadership, support and encouragement, participation, the own responsibility and how objectives, demands are adjusted to the existing situation were factors that were experienced to influence performance appraisal. Concerning the work environment was the comfort in the team and how the cooperation worked the foremost subjects that were discussed. Concerning lifestyle were the organisation’s health work, the responsibility for your own health and the balance between working life and leisure time discussed. <strong>Conclusion: </strong>The physical work environment is still important for the employees’ health as the units of proAros to a great extent consist of human services with a high workload. The question of how to find a balance is important for the work related health and therefore should the awareness of it be enlarged. The health promoting work should therefore also be integrated in performance appraisals.</p>

Bakgrund: Den största delen av den vuxna befolkningen befinner sig i arbetslivet och därför är arbetsplatsen en viktig arena i arbetet med att förbättra folkets hälsa. I verksamheters systematiska arbetsmiljöarbete finns verktyget medarbetarsamtal som syftar till att öka förståelsen för organisationens uppgift samt att ge medarbetaren ett större handlingsutrymme. Syfte: Att studera chefers och medarbetares upplevelser av hur arbetsmiljö och livsstilsfrågor diskuteras och behandlas i medarbetarsamtalet. Metod: Fyra fokusgrupper genomfördes med chefer och medarbetare från proAros olika verksamheter. Resultat: Mål, strategier, utveckling samt en enad riktning av verksamheten diskuterades som viktiga delar i medarbetarsamtalet. Tydligt ledarskap, stöd och uppmuntran, delaktighet, det egna ansvaret samt hur mål och krav är anpassade för den rådande situationen var faktorer som upplevdes påverka medarbetarsamtalet. Gällande arbetsmiljö diskuterades främst hur trivseln i arbetslaget var och hur samarbetet fungerade. Gällande livsstilsfrågor diskuterades friskvård, det egna ansvaret för sin hälsa samt balansen mellan arbetsliv och privatliv. Slutsats: Den fysiska arbetsmiljön är fortfarande av betydelse för de anställdas hälsa då proAros verksamheter till större delen består av människobehandlande yrken med påfrestande arbetsbelastningar. Frågan om att hitta balans är viktig för den arbetsrelaterade hälsan och bör därför göras mer medveten. Det promotiva hälsoarbetet bör därför integreras även i medarbetarsamtal. / Background: The majority of the adult population is present in working life and the workplace is therefore an important setting in the efforts to improve public health. In the organizations’ day-to-day work to improve the work environment it is possible to use performance appraisal that aims to increase the understanding for the organization’s commissions and to increase the employees’ participation. Aim: To study directors and coworkers experiences about how work environment and lifestyle are discussed and managed during performance appraisal. Method: Four focus groups where performed with directors and co-workers from different units at proAros. Result: Objectives, strategies, development, and a united direction in the organization were discussed as important for performance appraisals. Leadership, support and encouragement, participation, the own responsibility and how objectives, demands are adjusted to the existing situation were factors that were experienced to influence performance appraisal. Concerning the work environment was the comfort in the team and how the cooperation worked the foremost subjects that were discussed. Concerning lifestyle were the organisation’s health work, the responsibility for your own health and the balance between working life and leisure time discussed. Conclusion: The physical work environment is still important for the employees’ health as the units of proAros to a great extent consist of human services with a high workload. The question of how to find a balance is important for the work related health and therefore should the awareness of it be enlarged. The health promoting work should therefore also be integrated in performance appraisals.

Avhandlingens formål var en kompetansekartlegging av helsefremmende tilnærming i kontakten med brukere og bedrifter for ansatte i trygdeetaten i Norge. Etaten er en regelstyrt offentlig organisasjon i endring. Ved innføringen av ”Intensjonsavtalen om et mer inkluderende arbeidsliv”(IA-avtalen), fikk trygdeetaten tildelt ansvaret for å bistå virksomheter i privat og offentlig sektor med implementering av målsettingen om et inkluderende arbeidsliv. Arbeidslivssentre ble etablert og rådgivere ansatt. I studien inngikk en spørreundersøkelse besvart av 25 rådgivere. Kommentarer i åpnespørsmål ble analysert med kvalitativ metodikk. Oppgaven belyserutfordringen med åimplementere helsefremmende holdninger og metoder blant ansatte i en regelstyrt offentlig etat som trygdeetaten. Kartlegging og tolkning avdekker rådgivernes manglende kunnskaper om folkehelsearbeid. De har liten oversikt over sammenhenger mellom disse teorier/metoderog bistanden til bedrifter/brukere for å oppnå et mer inkluderende arbeidsliv. En spesiell utfordring ser ut til å være trygdefunksjonærenes holdninger til helse og sykdom. Begrensninger, årsaker og diagnoser har tradisjonelt et sterkt fokus. Det synes å væremindre bevissthet på helse som ressurs og betydningen av medvirkning/empowerment. Det ser også ut til å være etstort behov for mer kunnskaper om salutogenesis, dvs. betydning av opplevelse av sammenheng, mestring og trivsel på tross av sykdom og begrensninger / The aim of this study was to evaluate the employees of the Norwegian National Insurance Service, NIS, in their knowledge and experience on health promotion. NIS is a strictly traditional Public Organization ongoing managing change with the newly introduced reform “Tripartite agreement on a more inclusive workplace”. On behalf of the Government, theNIS has got the responsibility of assisting and supervising the Private and Public Organizations to improve and reach the aimsset in the agreement. The National Insurance Services Workplace Centres were established and advisers were employed. This study includes questionnaires answered by 25 advisers. Data, specific from comments in open ended-questions were analyzed by qualitative methods. The study shows thechallenge of implementing attitudes and methods on Health Promotion in a strictly traditional Public Organization like NIS. Analyzing the data showes a lack of knowledge in the advisers competence on Public Health theories and methods. They do not use elements of Health Promotion towards leaders and clients in private and public Enterprises in their supervising on “Inclusive Workplace”. Aspecial challenge seemed to be the advisers own attitude towards health and disease As a result of the analyses, recommendations for the employees/advisers of NIS are the needof more knowledge on Health Promotion, Empowerment and Salutogenesis. / <p>ISBN 91-7997-107-5</p>

Organophosphate (OP) pesticides, as a group, are the most widely used insecticides in Australia. Approximately 5 000 tonnes of active ingredient are used annually (Radcliffe, 2002). The OP pesticide group consists of around 30 identifiably distinct chemicals that are synthesised and added to approximately 700 products (Radcliffe, 2002). OP pesticides are used on fruit, vegetable, grain, pasture seed, ornamental, cotton, and viticultural crops, on livestock and domestic animals, as well as for building pest control. OP pesticides all act by inhibiting the nervous system enzyme acetylcholinesterase (AChE) and as such are termed anticholinesterase insecticides. The phosphorylation of AChE and the resultant accumulation of acetylcholine are responsible for the typical symptoms of acute poisoning with OP compounds. In addition to acute health effects, OP compound exposure can result in chronic, long-term neurological effects. The traditional method of health surveillance for OP pesticide exposure is blood cholinesterase analysis, which is actually biological effect monitoring. However, there are several drawbacks associated with the use of the blood cholinesterase test, including its invasive nature, the need for baseline levels and a substantial exposure to OP pesticide before a drop in cholinesterase activity can be detected. OP pesticides are metabolised fairly rapidly by the liver to form alkyl phosphates (DAPs). Approximately 70% of OP pesticides in use in Australia will metabolise into one or more of six common DAPs. During the last 30 years, scientists have developed a urine test that detects these six degradation products. However, unlike the blood cholinesterase test, there is currently no Biological Exposure Index (BEI) for the urine DAP metabolite test. Workers in the agricultural industry - particularly those involved with mixing, loading and application tasks - are at risk of exposure to OP pesticides. It is therefore important that these workers are able to assess their risk of health effects from exposure to OP pesticides. However, currently in Queensland, workplace health and safety legislation exempts the agricultural industry from hazardous substance legislation that incorporates the requirement to perform risk assessments and health surveillance (blood cholinesterase testing) for OP pesticide exposure. The specific aim of this research was to characterise OP pesticide exposure and to assess the feasibility of using urine DAP metabolite testing as a risk assessment tool for agricultural and related industry workers exposed to OP pesticides. An additional aim among farmers was to conduct an in-depth evaluation of their knowledge, attitudes and behaviours related to handling OP pesticides and how they assess the risks associated with their use of OPs. A cross-sectional study design was used to assess exposure to OP pesticides and related issues among four groups: fruit and vegetable farmers, pilots and mixer/loaders, formulator plant staff and a control group. The study involved 51 farmers in the interviewer-administered questionnaire and 32 in urine sample provision. Eighteen pilots and mixer/loaders provided urine samples and 9 exposed formulation plant staff provided urine and blood samples. Community controls from Toowoomba Rotary clubs provided 44 urine samples and 11 non-exposed formulation plant staff provided blood and urine samples; all groups also provided responses to a self-administered questionnaire. Participant farmers were drawn from the main cropping areas in south-east Queensland - Laidley/Lowood, Gatton, and Stanthorpe. The farmer group was characterised by small owner-operators who often had primary responsibility for OP pesticide mixing and application. Farmers had good knowledge of pesticide-related safety practices; however, despite this knowledge, use of personal protective equipment (PPE) was low. More than half of the farmers did not often wear a mask/respirator (56%), gloves (54%) or overalls (65%). Material Safety Data Sheets were never or rarely read and 88.2% of farmers never or rarely read OP pesticide labels before application. There were also problems with chemical suppliers providing farmers with MSDSs. The majority of farmers (90.2%) reported that they had never had any health surveillance performed and three-quarters had never read about or been shown how to perform a formal risk assessment. The main inhibitors to the use of PPE in the farmers' group included the uncomfortable and cumbersome nature of PPE, especially in hot weather conditions, and the fear of PPE use triggering neighbours' complaints to Government authorities. Factors associated with better PPE use included having positive attitudes and beliefs toward PPE use, higher knowledge scores and low risk perception. Farmers' use of OP pesticides was infrequent, of short duration and involved application via a boom on a tractor, a lower risk application method. Consequently, urine DAP metabolite levels in this group were generally low, with 36 out of 96 samples (37.5%) containing detectable levels. Detectable results ranged from 9.00-116.00 mol/mol creatinine. Formulators exposed to OP pesticides were found to have the highest urine DAP metabolite levels (detectable levels 13.20-550.00 mol/mol creatinine), followed by pilots and mixer/loaders (detectable levels 8.40-304.00 mol/mol creatinine) and then farmers. Despite this, pilots and mixer/loaders (particularly mixer/loaders) had the greatest number of samples containing detectable levels (94.4% of samples). The DAP metabolite most frequently detected across all groups was DMTP, which was the only metabolite found in control samples. Levels found in this study are similar to those reported in international research (Takamiya, 1994, Stephens et al., 1996, Simcox et al., 1999, Mills, 2001, Cocker et al., 2002). The observed DAP levels were not associated with a drop in cholinesterase activity among the formulation plant workers, as expected from the literature. Such exposure also is unlikely to be associated with acute health effects. In contrast, there is insufficient scientific knowledge to know whether levels recorded in this study and elsewhere may be associated with long-term, chronic health effects. Notably, DMTP levels also were observed among the presumably 'unexposed' comparison groups. Environmental background level exposures to OPs producing the DAP metabolite DMTP are therefore of potential significance and may be related, at least in part, to consumption of contaminated fruit and vegetables. There is also emerging evidence to suggest that exposure to DAP metabolites themselves through diet and other sources may contribute to the concentration of DAPs, including DMTP in urine, potentially complicating assessment of occupational exposures. Nevertheless, the urine DAP metabolite test was a useful, sensitive indicator of occupational OP pesticide exposure among agricultural workers and may be of use to the industry as part of the risk assessment process. Future research should aim to establish a BEI for the urine DAP test.

Despite the facts that vehicle incidents continue to be the most common mechanism for Australian compensated fatalities and that employers have statutory obligations to provide safe workplaces, very few organisations are proactively and comprehensively managing their work-related road risks. Unfortunately, limited guidance is provided in the existing literature to assist practitioners in managing work-related road risks. The current research addresses this gap in the literature. To explore how work-related road safety can be enhanced, three studies were conducted. Study one explored the effectiveness of a range of risk management initiatives and whether comprehensive risk management practices were associated with safety outcomes. Study two explored barriers to, and facilitators for, accepting risk management initiatives. Study three explored the influence of organisational factors on road safety outcomes to identify optimal work environments for managing road risks. To maximise the research sample and increase generalisability, the studies were designed to allow data collection to be conducted simultaneously drawing upon the same sample obtained from four Australian organisations. Data was collected via four methods. A structured document review of published articles was conducted to identify what outcomes have been observed in previously investigated work-related road safety initiatives. The documents reviewed collectively assessed the effectiveness of 19 work-related road safety initiatives. Audits of organisational practices and process operating within the four researched organisations were conducted to identify whether organisations with comprehensive work-related road risk management practices and processes have better safety outcomes than organisations with limited risk management practices and processes. Interviews were conducted with a sample of 24 participants, comprising 16 employees and eight managers. The interviews were conducted to identify what barriers and facilitators within organisations are involved in implementing work-related road safety initiatives and whether differences in fleet safety climate, stage of change and safety ownership relate to work-related road safety outcomes. Finally, questionnaires were administered to a sample of 679 participants. The questionnaires were conducted to identify which initiatives are perceived by employees to be effective in managing work-related road risks and whether differences in fleet safety climate, stage of change and safety ownership relate to work-related road safety outcomes. Seven research questions were addressed in the current research project. The key findings with respect to each of the research questions are presented below. Research question one: What outcomes have been observed in previously investigated work-related road safety initiatives? The structured document review indicated that initiatives found to be positively associated with occupational road safety both during and after the intervention period included: a pay rise; driver training; group discussions; enlisting employees as community road safety change agents; safety reminders; and group and individual rewards. Research question two: Which initiatives are perceived by employees to be effective in managing work-related road risks? Questionnaire findings revealed that employees believed occupational road risks could best be managed through making vehicle safety features standard, providing practical driver skills training and through investigating serious vehicle incidents. In comparison, employees believed initiatives including signing a promise card commitment to drive safely, advertising the organisation’s phone number on vehicles and consideration of driving competency in staff selection process would have limited effectiveness in managing occupational road safety. Research question three: Do organisations with comprehensive work-related road risk management practices and processes have better safety outcomes than organisations with limited risk management practices and processes? The audit identified a difference among the organisations in their management of work-related road risks. Comprehensive risk management practices were associated with employees engaging in overall safer driving behaviours, committing less driving errors, and experiencing less fatigue and distraction issues when driving. Given that only four organisations participated in this research, these findings should only be considered as preliminary. Further research should be conducted to explore the relationship between comprehensiveness of risk management practices and road safety outcomes with a larger sample of organisations. Research question four: What barriers and facilitators within organisations are involved in implementing work-related road safety initiatives? The interviews identified that employees perceived six organisational characteristics as potential barriers to implementing work-related road safety initiatives. These included: prioritisation of production over safety; complacency towards work-related road risks; insufficient resources; diversity; limited employee input in safety decisions; and a perception that road safety initiatives were an unnecessary burden. In comparison, employees perceived three organisational characteristics as potential facilitators to implementing work-related road safety initiatives. These included: management commitment; the presence of existing systems that could support the implementation of initiatives; and supportive relationships. Research question five: Do differences in fleet safety climate relate to work-related road safety outcomes? The interviews and questionnaires identified that organisational climates with high management commitment, support for managing work demands, appropriate safety rules and safety communication were associated with employees who engaged in safer driving behaviours. Regression analyses indicated that as participants’ perceptions of safety climate increased, the corresponding likelihood of them engaging in safer driving behaviours increased. Fleet safety climate was perceived to influence road safety outcomes through several avenues. Some of these included: the allocation of sufficient resources to manage occupational road risks; fostering a supportive environment of mutual responsibility; resolving safety issues openly and fairly; clearly communicating to employees that safety is the top priority; and developing appropriate work-related road safety policies and procedures. Research question six: Do differences in stage of change relate to work-related road safety outcomes? The interviews and questionnaires identified that participants’ perceptions of initiative effectiveness were found to vary with respect to their individual stage of readiness, with stage-matched initiatives being perceived most effective. In regards to safety outcomes, regression analyses identified that as participants’ progress through the stages of change, the corresponding likelihood of them being involved in vehicle crashes decreases. Research question seven: Do differences in safety ownership relate to work-related road safety outcomes? The interviews and questionnaires revealed that management of road risks is often given less attention than other areas of health and safety management in organisations. In regards to safety outcomes, regression analyses identified that perceived authority and perceived shared ownership both emerged as significant independent predictors of self-reported driving behaviours pertaining to fatigue and distractions. The regression models indicated that as participants’ perceptions of the authority of the person managing road risks increases, and perceptions of shared ownership of safety tasks increases, the corresponding likelihood of them engaging in driving while fatigued or multitasking while driving decreases. Based on the findings from the current research, the author makes several recommendations to assist practitioners in developing proactive and comprehensive approaches to managing occupational road risks. The author also suggests several avenues for future research in the area of work-related road safety.